Does sodium bicarbonate have a role in pediatric resuscitations?
Sodium bicarbonate is not recommended for routine use in pediatric resuscitations.
Although it is a useful agent for the reversal of documented metabolic acidosis, it is effective only in the presence of adequate ventilation.
When bicarbonate combines with hydrogen, it forms a complex molecule that splits into carbon dioxide and water.
The carbon dioxide has only one route of exit, the respiratory tract. Without effective ventilation, this by-product is not removed and the buffering capacity of the bicarbonate is eliminated.
A randomized, controlled trial found no benefit from sodium bicarbonate use in neonatal resuscitation. After provision of effective ventilation and chest compressions and administration of epinephrine, consider sodium bicarbonate for prolonged cardiac arrest.
American Heart Association: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 10: Pediatric Basic and Advanced Life Support. Circulation 2010;122:S466-S515.
Lokesh L, Kumar P, Murki S, Narang A: A randomized controlled trial of sodium bicarbonate in neonatal resuscitation—Effect on immediate outcome. Resuscitation 2004;60:219-223.